|Year : 2013 | Volume
| Issue : 1 | Page : 77-79
How to stop tobacco use? Tobacco user's perspective
Siddharth Sarkar, Akhilesh Sharma, Debasish Basu
Department of Psychiatry, Drug-De-Addiction and Treatment Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||24-Dec-2013|
Department of Psychiatry, Level 3, Cobalt Block, Post Graduate Institute of Medical Education and Research, Chadigarh - 160 017
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: To explore the tobacco-dependent subject's perspectives of what measures are likely to work for tobacco cessation. Materials and Methods: Nicotine-dependent male subjects attending a tertiary level de-addiction center in North India were recruited. Demographic and clinical data was recorded. Open-ended questions were asked to know user's perspective about the measures by which tobacco use can be effectively stopped in the country. The subjects were allowed as many responses as they desired. Results: A total of 46 subjects were recruited. The median age of the sample was 35 years, with median duration of tobacco use being 12 years. All subjects were males, and most were married, employed, and had urban residence. Supply reducing measures were the most commonly reported to stop tobacco (67.4% of subjects) followed by people quitting tobacco use by themselves (19.6%) and raising awareness through media (13.1%). Conclusion: This pilot study reflects the perspectives of tobacco users for the measures likely to be effective in tobacco cessation. Evaluating the effect of implementation of individual policies may help focusing towards measures that yield greatest benefits.
Keywords: Nicotine, reasons, stopping, tobacco, ways
|How to cite this article:|
Sarkar S, Sharma A, Basu D. How to stop tobacco use? Tobacco user's perspective. Ind Psychiatry J 2013;22:77-9
Tobacco use is considered as a major health hazard and is associated with millions of deaths worldwide.  To curb tobacco usage, steps have been taken at the international level aiming at both demand reduction and supply reduction. , Each country has implemented policies to minimize tobacco use and the consequent harms. Studies have been conducted to look for tobacco control measures that can effectively curtail the use of tobacco and consequent harms. ,, However, what measures will work in actually decreasing the tobacco use in a particular setting is not quite clear. , In attempts to formulate policies to curtail and regulate tobacco usage, it would seem logical to ascertain their perspectives about cessation of tobacco use. The tobacco-dependent population can give better insights about what measures are likely to work in stopping or reducing the tobacco usage. This study thus aimed to assess the measures tobacco users potentially think would work for stopping tobacco use.
| Materials and Methods|| |
The study was carried out at the Drug De-addiction and Treatment Center (DDTC) of the Post Graduate Institute of Medical Education and Research (PGIMER), a tertiary care hospital in Chandigarh, India. The DDTC caters to a variety of substance users and offers inpatient and outpatient services to the substance users. Dual diagnosis patients are also catered to and community outreach programs are carried out by the center.
Nicotine-dependent male subjects coming to the DDTC were offered participation in the study. Subjects who had been using nicotine in a dependent manner for at least 2 years were included. Subjects with major physical illnesses like chronic obstructive pulmonary disease and current users of alcohol or opioids in a dependent manner were excluded from the study.
Data collection was started after obtaining approval from the Institutional Ethics Committee. Information was obtained from the participants using a semi-structured questionnaire about the demographic details, clinical data, and opinion about the ways of stopping nicotine use in the country. The questions about reasons of use and measures that can be taken to stop tobacco use in the country were open ended and the responses of the subjects were noted in a descriptive manner. The participants were allowed as many responses they spontaneously reported. The responses were subsequently classified according to the themes that emerged, which were then used for semi-quantities analysis. Fagerström Test for Nicotine Dependence (FTND) was used to ascertain the degree of dependence on tobacco. All the information was gathered in a single setting.
The statistical analysis was done using SPSS version 15. Descriptive statistics was used to represent the findings on demographic and clinical data, reasons of use, and ways of stopping nicotine consumption in the country.
| Results|| |
A total of 53 individuals were approached for participation in the study, out of which five did not consent for participation and two were excluded due to active concomitant substance use. Information was obtained from 46 participants including 24 smokers and 22 smokeless tobacco users. The mean age of the sample was 35.5 years (median 35 years, range 21 to 55 years) with average use of nicotine for 14.8 years (median 12 years, range 2 to 40 years). The participants were all males, typically were married (71.8%), employed (76.1%), and lived in urban residence (65.3%). It was seen that 45.7% of subjects were educated above 10 th grade and the same number belonged to nuclear family. The mean FTND score was 5.8 (median 6, range 4 to 9), depicting moderate dependence. Harmful use or dependence of other substances including alcohol, opioids or cannabis was reported by a large proportion of the subjects (84.7%).
Among the ways of curtailing tobacco use, stopping supply was the most commonly reported measure reported (67.4% of the subjects). This broad theme included measures like stopping production in factories (45.7%), banning sale (19.6%), and effective enforcement of the laws at curtailing use (6.6%). Other measures included people attempting to quit tobacco use by themselves (19.6%) and raising awareness through media (13.1%). Interestingly, 3 participants (6.6 percent of the sample) said that use of tobacco cannot be stopped by any means. The suggested ways of stopping use are depicted in [Table 1].
| Discussion|| |
In our study conducted in a tobacco-using population, majority of the participants spontaneously endorsed tobacco control measures in the form of stooping the production and sale would be the most effective means of stopping tobacco use and the consequent harms. Studies exploring the measures of tobacco control have focused on supply reduction laws and have found benefit accruing from implementation of these. , It needs to be emphasized that supply reduction measures include many non-overlapping facets like taxation, tariffs on imports, banning sale to minors, and regulating the points of sale. Contribution of each of these factors may be difficult to dissect, but as a whole, they are likely to be quite beneficial. Previous papers from the region suggest that better implementation of the supply reduction laws can help in reducing widespread use of tobacco. ,
The limitations of the study include a small sample size and a limited number of questions being asked to the participants. The questions were posed to a clinic-going population, and generalization to non-clinical samples should be done with caution. However, it is expected that clinical population is one, which is more severely affected and at the extreme end of those with problems due to tobacco usage.
This preliminary study depicts the perspectives of tobacco users, about which measures are likely to be effective in tobacco cessation. Impact of implementation of individual policies needs to be critically evaluated, so that resources may be focused on those measures that yield maximum benefit.
| References|| |
|1.||World Health Organization. WHO report on the global tobacco epidemic, 2011 warning about the dangers of tobacco. Geneva: World Health Organization; 2011. |
|2.||Fronczak A, Polañska K, Usidame B, Kaleta D. Comprehensive tobacco control measures-the overview of the strategies recommended by WHO. Cent Eur J Public Health 2012;20:81-6. |
|3.||Sinha DN, Narain JP, Kyaing NN, Rinchen S. WHO framework convention on tobacco control and its implementation in South-East Asia region. Indian J Public Health 2011;55:184-91. |
|4.||Kulik MC, Nusselder WJ, Boshuizen HC, Lhachimi SK, Fernández E, Baili P, et al. Comparison of tobacco control scenarios: Quantifying estimates of long-term health impact using the DYNAMO-HIA modeling tool. PLoS One 2012;7:e32363. |
|5.||Macy JT, Chassin L, Presson CC. The association between implicit and explicit attitudes toward smoking and support for tobacco control measures. Nicotine Tob Res 2013;15;291-6. |
|6.||Moore K, Borland R, Yong HH, Siahpush M, Cummings KM, Thrasher JF, et al. Support for tobacco control interventions: Do country of origin and socioeconomic status make a difference? Int J Public Health 2012;57:777-86. |
|7.||Erguder T, Polat H, Arpad C, Khoury RN, Warren CW, Lee J, et al. Linking Global Youth Tobacco Survey (GYTS) data to tobacco control policy in Turkey-2003 and 2009. Cent Eur J Public Health 2012;20:87-91. |
|8.||Sinha DN, Gupta PC, Reddy KS, Prasad VM, Rahman K, Warren CW, et al. Linking Global Youth Tobacco Survey 2003 and 2006 data to tobacco control policy in India. J Sch Health 2008;78:368-73. |
|9.||Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2010;CD005992. |
|10.||Chaloupka FJ, Straif K, Leon ME; Working Group, International Agency for Research on Cancer. Effectiveness of tax and price policies in tobacco control. Tob Control 2011;20:235-8. |
|11.||Jandoo T, Mehrotra R. Tobacco control in India: Present scenario and challenges ahead. Asian Pac J Cancer Prev 2008;9:805-10. |